Healthcare Provider Details

I. General information

NPI: 1740118546
Provider Name (Legal Business Name): GENEVIEVE XU-HWA MOLLITOR L.AC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 W GENESEE ST STE 202
SYRACUSE NY
13219
US

IV. Provider business mailing address

808 STATE FAIR BLVD
SYRACUSE NY
13209
US

V. Phone/Fax

Practice location:
  • Phone: 315-220-0335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: